Mindfulness-Based Cognitive Therapy (MBCT) programme for depression in people with early stages of dementia: study protocol for a randomised controlled feasibility study

Occupational Therapist-Led Mindfulness Training Program for Older Adults Living with Early Cognitive Decline in Primary Care: A Pilot Randomized Controlled Trial

Background

Community-dwelling older adults with early cognitive deficits experience less efficiency in performing everyday life tasks, resulting in decreased satisfaction and other adverse psychological outcomes. Mindfulness training has been linked to cognitive and psychological improvements and, most recently, has been identified as a potential intervention supporting performance of everyday life activities.

Objective

This study aimed to evaluate whether mindfulness practice can improve perceived performance and satisfaction with everyday life activity and secondary psychological outcomes.

Methods

This study is a pilot randomized controlled trial (RCT) in an interprofessional primary care team practice in Toronto, Ontario, Canada. The participants were 27 older adults aged 60 years of age or older living with early cognitive deficits. Participants were randomized into an 8-Week mindfulness training program (n = 14) group or a Wait-List Control (WLC; n = 13) group compared at baseline, post-intervention and 4-weeks follow-up. MANOVAs with post-hoc independent t-tests were used to compare between groups at different time points.

Results

There was a significant improvement in anxiety for the intervention group compared to the WLC group at post-intervention; Time-2 (mean difference = 3.90; CI = 0.04-7.75; p = 0.04) with large effect size (d = 0.80).

Conclusion

Mindfulness training significantly improved anxiety scores for patients with early cognitive deficits post-intervention. Further work is required to test the sustainability of reduced anxiety over time, but this study demonstrated that MBSR is a promising primary care intervention for those living with early cognitive deficits. This study warrants the pursuit of a future study in exploring how long the reduced anxiety effects would be sustained.

A Biopsychosocial Model of Mealtime Management in Persons with Dementia, an Asset-Based Approach to Patient-Centered Care

Considering the rapid increase in the population over the age of 65, there is increasing need to consider models of care for persons with dementia (PWD). One common deficit associated with dementia progression is difficulty with successful participation in mealtimes. Difficulty participating in mealtimes in PWD is not the result of one factor, but rather a confluence of biological, psychological, and social characteristics common in dementia. Factors leading to mealtime difficulties for PWD may include changes in cognitive status, altered sensorimotor functioning, and increased reliance on caregiver support. The complex nature of biological, psychological, and social factors leading to mealtime difficulty highlights the need for a pragmatic model that caregivers can utilize to successfully support PWD during mealtimes. Existing models of dementia and mealtime management were reviewed and collated to create a model of mealtime management that considers this complex interplay. The Biopsychosocial Model of Mealtime Management builds on past research around patient-centered care and introduces an asset-based approach to capitalize on a PWD's retained capabilities as opposed to compensating for disabilities associated with dementia. We hope this model will provide a framework for caregivers to understand what factors impact mealtime participation in PWD and provide appropriate means on intervention.

The Feasibility of a Mindfulness Intervention for Depression in People with Mild Dementia: A Pilot Randomized Controlled Trial

OBJECTIVES

This preliminary study aimed to establish the feasibility of running an adapted Mindfulness Based Cognitive Therapy (MBCT) intervention for people with mild dementia and depression. It also aimed to conduct an exploratory analysis as to whether the MBCT intervention would lead to greater improvements in measures of depression, anxiety, quality of life and cognition, as compared to treatment as usual (TAU).

METHODS

A single-blind, multisite, feasibility randomized controlled trial was used. People with dementia and depression were recruited from participating memory services. Twenty participants were randomized to either an adapted MBCT and TAU group (n = 10) or TAU (n = 10). Measures of depression, anxiety, quality of life (QOL), and cognition were assessed at baseline and follow-up.

RESULTS

The intervention was feasible in terms of high attendance and low levels of attrition. It was not judged feasible to recruit enough participants within the recruitment time-frame. The MBCT group did not show significant improvements in depression, anxiety, QOL, and cognition at follow-up, as compared to TAU.

CONCLUSION

There is currently inadequate evidence to recommend this adapted MBCT intervention for people with dementia for the treatment of depression within memory services. The MBCT intervention needs redevelopment and piloting before further testing in an RCT.

Effectiveness of Dance-Based Interventions on Depression for Persons With MCI and Dementia: A Systematic Review and Meta-Analysis

Background: There is a growing need to offer appropriate services to persons with mild cognitive impairment (MCI) and dementia who are faced with depression and anxiety distresses beyond traditional pharmacological treatment. Dance-based interventions as multi-dimensional interventions address persons' physical, emotional, social, and spiritual aspects of well-being. However, no meta-analysis of randomized controlled treatment trials (RCTs) has examined the effectiveness of dance-based interventions on depression and anxiety among persons with MCI and dementia, and the results of RCTs are inconsistent. The study aimed to examine the effectiveness of dance-based interventions on depression (a primary outcome) and anxiety (a secondary outcome) among persons with MCI and dementia. Methods: A systematic review with meta-analysis was conducted. The inclusion criteria were: population: people of all ages with MCI and dementia; intervention: dance-based interventions; control group: no treatment, usual care, or waiting list group; outcome: depression and anxiety; study design: published or unpublished RCTs. Seven electronic databases (Cochrane, PsycINFO, Web of Science, PubMed, EBSCO, CNKI, WanFang) were searched from 1970 to March 2021. Grey literature and reference lists from relevant articles were also searched and reviewed. The Cochrane "Risk of Bias" tool was used to assess study quality. RevMan 5.4 was used for meta-analysis and heterogeneity was investigated by subgroup and sensitivity analysis. GRADE was applied to assess the evidence quality of depression and anxiety outcomes. Results: Five randomized controlled trials were identified. Sample sizes ranged from 21 to 204. The risk of bias was low, except for being rated as high or unclear for most included studies in two domains: allocation concealment, blinding participants and personnel. Meta-analysis of depression outcome showed no heterogeneity (I 2 = 0%), indicating that the variation in study outcomes did not influence the interpretation of results. There were significant differences in decreasing depression in favor of dance-based interventions compared with controls [SMD = -0.42, 95% CI (-0.60, -0.23), p < 0.0001] with a small effect size (Cohen's d = 0.3669); Compared with the post-intervention data, the follow-up data indicated diminishing effects (Cohen's d = 0.1355). Dance-based interventions were more effective in reducing depression for persons with dementia than with those having MCI, and were more effective with the delivery frequency of 1 h twice a week than 35 min 2-3 times a week. Also, one included RCT study showed no significant benefit on anxiety rating scores, which demonstrated small effect sizes at 6 weeks and 12 weeks (Cohen's d = 0.1378, 0.1675, respectively). GRADE analysis indicated the evidence quality of depression was moderate, and the evidence quality of anxiety was low. Conclusions: Dance-based interventions are beneficial to alleviate depression among persons with MCI and dementia. More trials of high quality, large sample sizes are needed to gain more profound insight into dance-based interventions, such as their effects of alleviating anxiety, and the best approaches to perform dance-based interventions.

Mindfulness-based cognitive therapy for depression in people with dementia: A qualitative study on participant, carer and facilitator experiences

Background

Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed.

Objective

This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators.

Methods

This qualitative study was nested within a randomised controlled feasibility study. Semi-structured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data.

Findings

Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups.

Conclusion

Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population.

Occupational therapist-led mindfulness-based stress reduction for older adults living with subjective cognitive decline or mild cognitive impairment in primary care: a feasibility randomised control trial protocol

INTRODUCTION

Community-dwelling older adults living with subjective cognitive decline or mild cognitive impairment may experience decreased efficiency in their overall functional performance. This decreased cognitive efficiency may result in anxiety, low mood, perceived stress and decreased emotional well-being and quality-of-life. These psychological symptoms may further exacerbate cognitive decline.Exploring non-pharmacological interventions such as mindfulness within primary care is vital in enabling individuals to develop strategies to manage cognitive impairment or psychological symptoms. Mindfulness-based stress reduction (MBSR) is an 8-week programme that is beneficial in alleviating psychological symptoms; however, its impact on perceived satisfaction on overall functional performance with this population has not been evaluated. The primary objective of this study is to explore the feasibility of conducting a randomised controlled trial of an occupational therapist-led MBSR programme within primary care.

METHODS

Convergent mixed-methods, randomised control feasibility trial with 40 participants from an interprofessional primary care team in Toronto, Ontario. Participants are randomised into the 8-week MBSR group or wait-list control will be compared at baseline, postintervention and 4weeks follow-up. The primary aim is to determine the feasibility of the intervention with this population and setting. The secondary aim is to examine perceived satisfaction with functional performance as measured by the Canadian Occupational Performance Measure. Secondary clinical outcomes include psychological symptoms.

ANALYSIS

Investigators will analyse the quantitative and qualitative data strands separately. Descriptive statistics, focus group and interviews will then be merged and further analysed to best understand the feasibility and preliminary clinical outcomes from the study.

ETHICS AND DISSEMINATION

The study is approved by Women's College Hospital (2017-0056-E), and Queen's University, Kingston, Ontario (6026418). The study will follow Standard Protocol Items: Recommendations for Interventional Trials. The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.Trial registration numberNCT03867474; Pre-results.

Meditation-Based Interventions for Adults With Dementia: A Scoping Review

IMPORTANCE

With the high prevalence and cost of dementia care worldwide, a need exists to develop cost-effective and evidence-based treatment for people with dementia. Meditation, which has been demonstrated to have positive effects on brain health, may be a viable intervention option.

OBJECTIVE

To investigate how meditation-based interventions affect health and quality-of-life (QOL) outcomes for adults with dementia.

DATA SOURCES

Articles were located by using the keywords meditation, mindfulness, mind-body, dementia, and Alzheimer's to search the following electronic databases: PubMed, CINAHL, Embase, Cochrane, and JumboSearch at Tufts University.

STUDY SELECTION AND DATA COLLECTION

Using Arksey and O'Malley's methodology, a scoping review was conducted to examine scientific and gray literature published between 1997 and 2018. Data were abstracted and assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Only articles that included a meditation-based intervention and at least 1 participant with dementia were included.

FINDINGS

Nineteen articles met inclusion criteria. The four main outcomes that emerged from the literature were improvement in QOL, mental health, cognition, and functional abilities after participation in a meditation-based intervention. The outcome with the strongest support was the effectiveness of meditation-based interventions in maintaining cognitive function in people living with dementia. Significant gaps in the research were identified, including weak research design, inconsistency in measurement of outcomes, small sample sizes, and a lack of standardized meditation protocols for people with dementia.

CONCLUSIONS AND RELEVANCE

Our findings suggest that incorporating meditation into interventions for clients with dementia can have beneficial results. Opportunities exist for occupational therapy practitioners to advocate for the continuation of research in this field. Notable gaps in the literature highlight the need for randomized controlled trials and the development of standardized meditation protocols for people with dementia.

WHAT THIS ARTICLE ADDS

Meditation-based interventions for people with dementia are associated with improved quality of life and cognition and may be viable treatment options for occupational therapists to implement in their practice.